A Gut-Wrenching Experience, Part Seventeen: Not A Very Pleasant Thing To Watch

The transfer to the ICU was carried out with brisk efficiency. John tried to squelch his apprehension as his bed was wheeled out of the general med/surg floor he had been on, and through the corridors and several sets of automatic double doors. Sherlock trailed after, with his and John's personal effects.

They settled him into his room. This time, there were no pleasantly blank walls to shield him from the eyes of the staff; he was in a cubicle of mostly glass. Curtains hid the view into the other patients' rooms and another, half-drawn, hung on the glass door that faced the nurses' station. He did have a large window to the outside, but since they parked his hospital bed facing away from it he doubted he'd be seeing much of the London skyline.

Sherlock sank into the fold-out armchair as the nurse hooked John up to the monitors and switched him over to a new CPAP machine. She wore dark-blue scrubs and a nametag that read 'Melanie, RN', and smiled at John as he asked a few hoarse but important questions. Her long dark braid and honey-coloured skin, and slight lilt to her voice, made him think she was probably from an Indian family… or perhaps Pakistani? Sherlock has probably figured out what village her family came from, her religion, and how long they've been in Britain, he thought to himself.

"We've a fairly liberal visitor policy here," she reassured him. "Unless you're undergoing a procedure or you're very unstable, you're allowed to have one support person here as much as you would like. Otherwise, no more than two visitors at a time… although it's a rule we break if there is a good reason. And of course, if we think you're not getting the rest and quiet that you need, we chase everyone out for a while."

"That's fine." That had been one of John's biggest fears, that Sherlock would only be allowed brief visits or only during certain hours. He knew that his friend would need to occasionally get away from the hospital, but he selfishly hoped that he wouldn't be left alone any more than necessary.

Melanie pointed out the call button, placed carefully near John's left hand, and made sure that he was able to press it. "Don't worry if you hit it by accident… we know you don't have a lot of strength right now. I'd much rather have a false alarm or two than have you feeling ignored." She also placed the remote for the television nearby, and (to his acute embarrassment) hung a plastic portable urinal off of one side of his bed. "You've got a fold-out commode over there as well," she explained, pointing to one side of his cubicle, "but you are absolutely not to get out of bed without help."

She patted his blankets one more time and smiled again. "Let's get your PFTs done. I'll send in our RT to do that as soon as he has time, plus we have orders to get a chest x-ray on you." Her face grew more solemn. "If we do need to put you on the ventilator, we want to have everything ready."

As she left, twitching the curtains fully closed behind her, he looked at Sherlock. "Well," he said with a certain amount of forced cheerfulness, "this doesn't look too bad so far."

Sherlock said nothing, but pulled his knees up to his chest and wrapped his arms around them. "No," he said at last. "No, but all the same, I hope you don't have to be in here for very long."

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The radiology tech got there first, with a portable x-ray machine. He took his pictures and left without saying very much. All too soon, the RT (a different one than he'd met the night before, tall and skinny) was there to check John's lung capacity. He coached John through the process, as if he hadn't already done it the day before.

"Okay, now blow, blow, blow…. Hard as you can, just a little longer, now, don't take a breath just yet, okay, now you can!" He looked at the readout on the computer, frowned just briefly, and then quickly smiled again at John. "That was your first one. They like us to do three tries, and then we go with your best result."

John nodded, and dutifully followed directions for two more attempts. He could tell, though, that his breathing effort was weaker than it had been the day before, even without seeing the results. It didn't feel like his chest muscles and diaphragm were sucking in enough air to make a difference, without the assistance of the CPAP (temporarily off his face for this test).

When all three tries were completed, John fixed the RT with what he hoped was his best steely officer/doctor expression.

"How bad is it?"

The RT didn't look at him. "Well, definitely a lot worse than yesterday," he said slowly. "I need to go show it to Dr. Powers. He'll be in to tell you what we do next."

He got John's CPAP mask fitted back on his face and adjusted the machine to his satisfaction, then nodded at his patient and left. John sighed and looked over at Sherlock.

"Well, here we go."

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The pulmonologist didn't beat around the bush.

"Dr. Watson, we need to put you on the ventilator."

John grimaced. "Please, call me John."

The specialist's facial expression softened a little. "John, then. Your respiratory muscles are getting rapidly weaker, and you're at risk for sudden respiratory failure. Or just gradual failure and CO2 retention. You need the help."

"Doesn't sound like I have much choice," John said slowly. He was already feeling more short of breath, and talking was becoming difficult.

"The good news is that your lungs themselves are beautifully healthy. Your chest x-ray looks great, except for a few small areas of alveolar collapse. But we'll pop those back open again with the ventilator. You've never smoked?"

John shook his head.

"So, healthy lungs will help. We just need to support you until the IVIG has a chance to work and your nerves start working properly again."

"When?" John forced the words out. "When are you going to intubate me?"

The specialist took a deep breath. "In just a few minutes, as soon as well have everything set up. I'll take your wishes into account, just like you wrote out… just enough sedation and pain meds to make sure you aren't conscious for the intubation itself, then we'll back off and only give you enough to make sure you aren't in pain or overly anxious." He turned to Sherlock.

"For this part," he said apologetically, "I'll have to ask you to step out, Mr…."

"Holmes. Sherlock Holmes."

"It's not a very pleasant thing to watch, Mr. Holmes, so we'll send you out to the visitor lounge for a little while."

He looked at John, who saw the question in the pale eyes. John nodded at him.

Sherlock stood. "Will I… may I come back to be here when he wakes up?"

The specialist nodded. "Yes, very much so. In fact, we'd appreciate it if you did. A newly intubated patient – even a physician, who understands the situation – can become frightened or agitated when they wake up, and having a trusted, familiar face and voice nearby is very helpful. We'll send someone for you as soon as we know that the tube is in a good position."

Sherlock stood and took a step closer to the bed. His eyes met John's for a long moment, with a searching gaze, and he reached down and touched John's hand for a few seconds. Then he turned on his heel and left the room. John's hand felt noticeably colder to him after that touch was gone.

He cleared his throat and looked at the doctor. "Let's get this over with, then."

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Sherlock walked out of the double doors of the ICU and then realised that he didn't know where the visitor lounge was located. But the smallish room was in the logical place, just to the left outside of the ICU doors. He entered the dimly lit space and sat down in a corner. There were a few other people there; two were napping on sofas and three were engaged in quiet conversation with each other.

He pulled out his mobile phone, and impulsively sent a text to Mycroft.

John is in hospital. Very ill. About to be put on the ventilator.

He wasn't entirely sure why he sent the message. He knew that while Mycroft could be of help in many situations, if he chose, a medical emergency wasn't one of them. John was getting excellent care and no amount of interference from someone with political influence could buy him any better. Of course, Mycroft liked and respected John; perhaps that was reason enough to let him know.

He didn't admit to himself that he was frightened and wanted his big brother to tell him that everything would be all right.

There was no immediate response; Mycroft was probably in a meeting. Sherlock wasn't certain if he was disappointed or relieved. He put the phone back in his jacket pocket and leaned his head against the sofa back, trying to compose himself and trying not to think about the latent fear he had seen in John's eyes a few moments ago.

He almost jumped when he felt his phone buzz. He answered it quickly.

"Sherlock Holmes," he said, even though he could clearly see if was Mycroft.

"What does he have?"

"Guillain-Barre syndrome." He spelled it for Mycroft, then waited. He could hear keyboard clicks and knew that his brother was looking up a quick description of the disease and skimming it for the salient points.

"You say they are putting him on the ventilator?"

"Yes. He's just not breathing well enough on his own." He felt his throat began to ache with unwelcome emotion. "It might be just for a day or two, or…" He stopped, fighting to regain control.

"I can be there in about 20 minutes, Sherlock. Do you want me to come to the hospital?"

His brother's unexpected, matter-of-fact kindness almost undid him completely. "I … I don't know. I'll know more in a little while, when they let me back in. I don't think he's up to a lot of visitors right now."

"That's not what I asked."

Sherlock took a deep breath, sensing the subtext. "I'm all right." I'm not planning on letting my grief and worry drive me to cocaine or heroin, dear brother.

"You're certain?"

"Yes. I just thought you should be aware of what was happening."

"Keep me updated, Sherlock. I, too, am fond of John Watson."

"I will," he promised, and cut the connection before his voice could start to shake any more.

He sat there, alone in the semi-darkness except for strangers, until John's dark-haired nurse came to get him.